HomeMy WebLinkAboutMortgage_Powers^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTED� C 7ownship Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
�' • StateFOrmC3709IR11/6-W)
S ,,,, � P����,��«����F� JUL
File Mark
�ISTRUC710NS: C. �, �
Form filed wiN:
To be �led in person w by maii wifh the Counry Auditor or Counry Recorder o/ the counry wfiere the property is I
Fi7'vg Dates: 7) Real Property Must file durirq the year fir which the deduction is sought. „� County Auditor
2)MO6de/ManufacturedHomesnotassessedasRealPropertyMustfiledun��(AS61�f��(��t�is�DIT CountyRecorder
6efore March 31 ot each year the deducfion is sought R�
See reverse sMe for adddional instmctions and qualfications.
Appfic/a�nt)(�wneror �oonfrdrY buye�- s on reverse side
/�/JHn//wn. ����/�in�i...n ) /7)�'On
.�.�m��� �
AseseE rdhm cf �1 p�apel;y at d
Maid� t. aarem year
I( ro, what a his / her e�d share of ii
If rwne m remftl it tliRerenl ihan Na'
Name of mwigagee or crntreG seller
Address o( rrortgagce or mntrad sW
Name of "`:�nee w oNer avmer or t
Address
zo
Key rvmber / legal desaiption
,�i _i 9� �_ti
o( appi"ran. udica[e bebw.
��.
streeG ary, s'ate, am ur coae�
rant wm pmpeM1y in any alher
�diana?
❑ Yes
���a��of
sig�tufe o(COUnbnW"rtur
20
It yes. vTal c
�_
- 0�5 dG1�3 ��-5
aMOngageP� uMebtedness unPaid as d ��� e avme/?
❑ Yes ❑ No
If wmed wi� someo� oNer Ihan spouse. iMrate wtrh Minm
Is Me OroPPrtY in qurstion: MnuaDy AssesseE
�jteal ProPertY ❑ Mnually A55essed
Modle Fiatie (IC 61.
DraF��er iVp,,,,�i�i�
�....
Card i�'O. .. � �,-,,�„U�
y 5, c��. �v .....
zo I �— i ---
Caunry
auested m pfoperty
] Yes ❑
, zo _
I/ We certify under the penalry of perjury thai the above arM foregoing informalion is W e and corteU and that Me applirant is a resident of I�iana ard
owner / wn4acl buyer of the aforementioned pmperty on date applicalion is filed.
i�nue (o�me/s /u9 reme) �1 _ Date (month. daY. Y��
of
�mber an0 sheet, r4y, state, a LP ca
�00 S �riY
paw¢r p(AttorneY a �Y IC 67.1-72�.7
AdtlressofaWio�rsedperson (numbuaritlsLee4
r
Date (manN. daY• Yaa�